微创颅内血肿清除术治疗脑出血65例

我科于1999年10月以来,对各种原因引起的脑出血(出血量≥30 ml)的患者采用贾保祥[1]教授研制的微创颅内血肿清除术进行治疗,取得了良好效果。现报告如下。1临床资料1.1一般资料本组65例,男38例,女27例,发病年龄32岁-83岁,平均年龄56.2岁。其中高血压引起的脑出血63例,急性硬膜下血肿2例,超早期(发病7 h内)就诊28例,早期(发病7 h~3 d)就诊35例,延期(发病3 d以上)2例。1.2临床表现大部分患者发病早期均有头痛或头晕,其中呕吐52例,有高血压史者59例,有头部外伤史2例。神志清醒者17例,昏迷48例,其中深昏迷18例,中度昏迷21例,浅昏迷9例。61例偏瘫…     

前房穿刺在小梁切除术中的应用

报告３５例（４１只眼）青光眼小梁切除术合并行前房穿刺。在手术的过程中,通过前房穿刺口放出房水,注入平衡盐溶液来调节眼内压,促使前房形成,防止浅前房发生,人工形成滤枕。结果显示小梁切除术合并行前房穿刺,可以减轻手术并发症,使手术获得更理想的效果     

Perforation during gas reduction of intussusception

Perforation during attempted gas-enema reduction of intussusception is more common than during a barium enema. In a review of 650 consecutive attempted gas enemas, perforation occurred in 7 infants (1.1%). Gross abdominal distension from the pneumoperitoneum may be rapid and cause splinting of the diaphragm, which leads to acute respiratory distress. This complication is readily recognised at the time of the gas enema, and may require immediate intervention by paracentesis using a 14-gauge needle. A review of 7 children with intussusception in whom perforation occurred revealed that all had radiologic evidence of bowel obstruction (air-fluid levels) prior to the enema, and the patients had had a relatively long history since the onset of symptoms. No perforation occurred during a delayed repeat enema reduction. Perforation during gas enema produces minimal peritoneal contamination. No pathological lesion at the lead point of the intussusception was identified in any of the children in whom perforation occurred.     

Economic evaluation of long-term albumin use in cirrhosis patients from the Mexican healthcare system perspective

Introduction and objectivesLiver cirrhosis is a major public health issue associated with high morbidity and mortality. The ANSWER trial showed that long-term human albumin (LTA) infusions led to significant reduction of complications and mortality in patients with uncomplicated ascites. The present study aimed to assess the incremental cost of cirrhosis patients treated with LTA plus standard medical treatment (SMT) versus those treated with SMT from the perspective of the Mexican Social Security Institute (IMSS).Material and methodsCost of illness for patients with cirrhosis and grade 2-3 ascites treated with SMT or with SMT and LTA (following the treatment regimen from ANSWER) over a one-year period was estimated according to the IMSS perspective. Rates of treatments, complications and hospitalizations were based on results from the ANSWER trial. Unit costs from IMSS were gathered from public sources and transformed to 2020 Mexican $ (Mex$).ResultsThe use of LTA is estimated to require additional annual expenditure derived from the pharmacological cost of human albumin and by the follow up visits required for LTA administration (Mex$28,128). However, this cost may potentially be counterbalanced by the reduction in paracentesis, cirrhosis-related complications and hospitalizations which would lead to cost savings of Mex$33,417 per patient/year.ConclusionsBased on the ANSWER trial results, our study suggests that LTA may result in improved clinical outcomes and reduced costs for the IMSS when administered to cirrhosis patients with uncomplicated ascites.     

microRNA在急性胰腺炎患者外周血中表达的意义

目的 通过检测血清microRNA变化,预判急性胰腺炎的病情严重度并探讨影响经皮置管引流(PCD)治疗的因素.方法 回顾性分析2013年10月至2014年3月成都军区总医院收治的120例急性胰腺炎患者的临床资料并采集其外周血,35例急性重度胰腺炎(SAP)、急性中重度胰腺炎(MSAP)为A组,85例急性轻度胰腺炎(MAP)为B组.对所有患者进行APACHE Ⅱ、Reason、BISAP评分,用实时定量PCR法进行定量检测患者血清中miR-146a、miR-10b、miR-21、miR-26a表达水平,比较两组之间的4种microRNA表达差异以及与评分系统间的相关性,并分析影响PCD治疗的因素.计量资料采用t检验,变量间关系采用直线相关分析.单因素和多因素分析采用Logistic回归.结果 (1)APACHEⅡ、RANSON、BISAP评分:A组分别为(8.28±0.61)分、(3.42±0.54)分、(1.71±0.32)分;B组分别为(3.18±0.52)分、(1.43±0.25)分、(0.37±0.06)分,两组比较,差异有统计学意义(t=4.266,7.809,4.113,P＜0.05).(2)血清miR-146a、miR-10b、miR-21、miR-26a表达水平:A组分别为1.41±0.21、2.94±0.49、1.62±0.25、1.21±0.20;B组分别为6.29±0.91、0.52±0.09、2.82±0.33、3.57±0.64.miR-146a、miR-10b在两组间差异有统计学意义(=-2.156,2.110,P＜0.05),而miR-21、miR-26a两组间差异无统计学意义(t=-1.114,-1.571,P ＞0.05).(3)相关性:A组miR-146a、miR-10b与APACHEⅡ、RANSON、BISAP评分有相关性(r=-0.826、0.837,-0.874、0.866,-0.833、0.899,P＜0.05).而miR-21、miR-26a表达水平与APACHE Ⅱ、RANSON、BISAP评分无相关性(r=0.642、0.321,0.701、0.750,0.716、0.716,P＞0.05).B组miR-146a、miR-10b、miR-21、miR-26a表达水平与APACHE Ⅱ评分无相关性(r=0.067,0.347,0.133,0.111,P＞0.05);与RANSON评分无相关性(r =0.178,0.078,0.092,0.142,P＞0.05);与BISAP评分无相关性(r=0.103,0.260,0.216,0.285,P＞0.05).(4)预测因素分析:单因素Logistic回归分析发现RANSON评分、BISAP评分、miR-10b是影响PCD干预的因素(OR =4.170,5.612,2.500;95％可信区间:1.092 ～ 15.932,1.232 ～21.622,1.190 ～5.254,P＜0.05).多因素Logistic回归分析发现miR-10b是急性胰腺炎PCD干预的独立影响因素(OR=2.374,95％可信区间:1.115 ～5.056,P＜0.05).结论 miR-10b与miR-146a可能成为判断急性重症胰腺炎严重程度的预测指标;miR-10b可能成为急性胰腺炎是否行PCD干预的判定指标.     

改进型前房穿刺术治疗视网膜中央动脉阻塞临床研究

目的评价随机采用传统治疗方式与改进方式对视网膜中央动脉治疗效果的差异。方法对确诊为视网膜中央动脉阻塞（CRAO）54例（54只眼）患者给于吸氧、局部及全身改善循环治疗，并给予静脉大剂量尿激酶治疗。传统组患者采用常规前房穿刺，改进组采用改进型前房穿刺治疗患眼。观察治疗前后视力变化，进行眼压监测以及荧光素眼底血管造影（FFA）检查。结果对治疗后视力变化分类统计，应用Wilcoxon等级资料秩和检验分析，传统改良组视力较传统改良组视力提高有统计学意义（P〈0．01）。传统改良组前房穿刺后未见并发症增多。治疗后1周进行FFA检查，传统组2只眼，传统改良组5只眼，显示视网膜血管充盈正常。结论改进型前房穿刺术在CRAO的综合治疗中拥有经济，简便，高效的特点。     

睫状体冷冻术联合前房穿刺术治疗绝对期青光眼的临床观察

目的分析睫状体冷冻术后眼痛症状的成因及联合前房穿刺术后对减轻眼痛症状的帮助.方法本文对我科实施单纯睫状体冷冻术的23例23跟（A组）及实施睫状体冷冻术联合前房穿刺术的8例8眼（B组）出现疼痛及其持续时间进行对比分析.结果A组出现疼痛症状的为23例23眼（100%）,持续时间3～10 d,平均6.8 d;B组出现疼痛症状的4例4眼（50%）,持续时间1～3 d,平均2.3 d,差异有显著意义（P＜0.005）.结论睫状体冷冻术联合前房穿刺术可以有效地减轻术后疼痛症状,减轻患者痛苦.     

超声引导下经皮穿刺置管多次灭能术治疗囊肿的价值

目的 探讨安全高效的囊肿治疗方法.方法 对65例(肝、肾、卵巢)囊肿患者, 采用超声引导下穿刺置入COOK公司产7F引流管行囊肿穿刺、引流、灭能术治疗,并留置引流管2～3 d,用无水乙醇对囊肿壁灭能2～3次.结果 随访1.5年,65例患者中囊肿消失痊愈61例,痊愈率93.8%;囊肿明显缩小(直径＜1/3)但仍残有囊腔3例,总有效率98.5%;复发1例.无腹腔出血及化学性腹膜炎发生.结论 应用超声引导下经皮穿刺置管多次灭能术治疗囊肿方法安全有效.     

微创穿刺清除术在基底节区脑出血治疗中的临床应用

目的探讨微创穿刺血肿清除术治疗基底节区高血压脑出血的临床疗效。方法选取行微创穿刺血肿清除术治疗的高血压基底节区脑出血患者61例作为观察组,选取同期行内科保守治疗的高血压基底节区脑出血患者47例作为对照组。比较两组患者神经功能恢复情况、血肿清除率、日常生活活动能力及死亡情况。结果微创穿刺清除术患者治疗3周后神经功能缺损评分、血肿清除率及治疗后3个月的日常生活活动能力恢复情况均明显优于对照组(P0.05)。微创穿刺清除术患者的病死率略低于对照组,差异无统计学意义(P0.05)。结论微创穿刺引流术治疗基底节区脑出血手术创伤小、血肿清除率高,有利于患者神经功能缺损的恢复。     

鼻外额窦穿刺术

本文介绍鼻外额窦穿刺术治疗急性额窦炎16例(18侧),全部治愈,随访3个月无复发。该法操作简单,创伤小,并发症少。文中介绍了手术适应症、操作方法和一些技术细节。